Modi Parth K, Yan Phyllis, Hollenbeck Brent K, Kaufman Samuel R, Borza Tudor, Skolarus Ted A, Schroeck Florian R, Ryan Andrew M, Shahinian Vahakn B, Herrel Lindsey A
Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Urol Pract. 2020 Sep;7(5):419-424. doi: 10.1097/upj.0000000000000123. Epub 2020 Sep 1.
To examine three aspects of urologist practice structure that may affect quality of prostate cancer care: practice size, ownership of an intensity modulated radiation therapy (IMRT) device, participation within a multi-specialty group (MSG). Health care reforms focused on improving quality are particularly relevant for prostate cancer given its prevalence and concerns for overdiagnosis and overtreatment.
Using data from the Surveillance, Epidemiology and End-Results (SEER)-Medicare linked registry, we examined quality of prostate cancer treatment according to each treating urologist's practice size, type (single-specialty vs. MSG) and ownership of IMRT. Mixed models were used to adjust for patient differences.
We identified 22,412 men with newly diagnosed prostate cancer treated by 2,199 urologists during the study. We observed minimal differences for most quality metrics according to practice size, type, and ownership of IMRT. Adherence to all eligible quality metrics was better among MSGs compared to single specialty groups (20.0% adherence versus 18.2%, p=0.01) whereas there was no significant difference by ownership of IMRT (17.1% adherence in owners versus 18.9% non-owners, p=0.09).
Differences in quality across practice size, type and ownership of IMRT were modest, with substantial room for improvement regardless of practice structure.
研究泌尿外科医生的执业结构中可能影响前列腺癌治疗质量的三个方面：执业规模、拥有强度调制放射治疗（IMRT）设备、参与多专科团队（MSG）。鉴于前列腺癌的患病率以及对过度诊断和过度治疗的担忧，专注于提高质量的医疗改革与前列腺癌尤为相关。
利用监测、流行病学和最终结果（SEER）-医疗保险关联登记处的数据，我们根据每位治疗泌尿外科医生的执业规模、类型（单专科与MSG）和IMRT设备拥有情况，研究了前列腺癌治疗质量。使用混合模型来调整患者差异。
在研究期间，我们确定了2199名泌尿外科医生治疗的22412名新诊断前列腺癌男性患者。我们观察到，根据执业规模、类型和IMRT设备拥有情况，大多数质量指标的差异极小。与单专科团队相比，MSG对所有符合条件的质量指标的依从性更好（依从率分别为20.0%和18.2%，p = 0.01），而IMRT设备拥有情况之间没有显著差异（拥有者的依从率为17.1%，非拥有者为18.9%，p = 0.09）。
无论执业结构如何，IMRT的执业规模、类型和拥有情况在质量上的差异都不大，仍有很大的改进空间。
